Healthcare Provider Details

I. General information

NPI: 1699856435
Provider Name (Legal Business Name): BRENDA RUSSELL DUNN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 11/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 DANIEL MCCALL DR STE 21
LUFKIN TX
75904-7191
US

IV. Provider business mailing address

3402 DANIEL MCCALL DR STE 21
LUFKIN TX
75904-7191
US

V. Phone/Fax

Practice location:
  • Phone: 936-637-3300
  • Fax: 936-634-3384
Mailing address:
  • Phone: 936-633-6245
  • Fax: 936-634-3384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16181
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: